Health Care Advocate

The flow of care follows the money.

To achieve the health care system that we desire, we must come to grips with the way economics works. Sadly, the debate of the modern world has been dominated by the absurd delusion that, if we changed human nature, we could change the forces of economics.

The flow of care follows the money. When funds for healthcare flow from a pool, a bureaucratic layer will form around the pool to protect the pool. This rule applies to both government and privately owned pools.

No matter how we conceive the system, when funding for health care comes from a collective, the care for the system will bend to the needs of the collective and not to the needs of the individual.

If we really wanted a dynamic change in the way that we deliver health care, then we should change the funding mechanism so that the resources for health care flow from the individual.

The accounts in a Medical Savings and Loan accomplish exactly this transformation. With the MS&L people have the resources to directly fund their care.

Transformation of the Bureaucracy

The change from a pool based to an individually based system would manifest immediately in a change in the bureaucracy.

The insurance industry has developed a specialty called a "Claims Adjuster." The Claims Adjuster approves, adjusts or rejects claims for health care expenses. There is often a battle between claims adjusters and hospital billing agents. There are all sorts of internal wars where billing agents over charge and adjusters underpay for medical care. It is really a silly system.

The primary goal of the claims adjuster is to protect the integrity of the pool. The adjuster is not an evil person. The claim adjuster realizes that, by protecting the integrity of the pool, they protect the members of the pool. Claims adjusters often bend over backward to help people receive the care they need. They are vilified in the press when they deny claims.

Claims adjusters are not simply nay-sayers. They want policy holders to experience the largess of the pool, while making decisions at critical points to protect the system from fraud and abuse.

The Medical Savings and Loan does not eliminate the health care bureaucracy. There will still be people looking to abuse the system.

Specifically, the system will need a class of bureaucrats to approve loans and make sure health care expenses are legitimate.

Since the money in the Medical Savings and Loan flows from the patient, the role of the bureaucrat will change from one of protecting the pool to protecting the resources of the individual. The bureaucrat will play the role of an advocate rather than a claims adjuster.

The advocate's goal is to work with clients to help optimize the return on their health investments. As such, the advocate would take the tact of talking people out of expenses they didn't need opposed to the claims adjuster who simply denies claims.

An advocate would spend a great deal of time working with clients helping them budget in anticipation of future expenses. With a focus on long term costs, an advocate would approve loans for expenses that could stave off future costs. A good advocate would also be quick to talk people out of expenses that they could put off. Health maintenance is something that should be done on a scheduled basis and not all at once.

As the healthcare advocate is concerned with the financial health of a client, the advocate should expend efforts investigating alternatives and would aid patients in negotiations with the health care provider.

A healthcare advocate would need the ability to deny loans and expenses for things that fall outside of healthcare. For example, they should deny the use of medical loans to buy a new car, or they might reject paying for tanning sessions reasoning that a tan only makes you look healthy, it does not make you healthier.

The advocate would also provide a crucial role in helping people store, organize and interpret their health care records.

Conclusion

Good health care involves the application of knowledge, time and resources to the maintenance of one's health. Unfortunately, the bureaucracies around health care have evolved for the benefit of the big insurance companies, big government regulators and big hospitals.

This information in the system is optimized for their use and not for the use of the patient.

The Medical Savings and Loan realizes that the paperwork will follow the flow of the money. As such, the MS&L creates a fundamental change that would have the money flowing from the patient. Consequently the paperwork would flow back into the hands of the patient and the bureaucracy would become focused on the needs of the patient.